Emotion Recognition is Impaired in "Healthy" Siblings of People With Schizophrenia

There is a new study, published in the British Journal of Psychiatry, on facial expression and emotion recognition difficulty in those with genetic vulnerability to schizophrenia. This area is important because it highlights the belief by many schizophrenia researchers that there are a significant percent of people in families that have a genetic predisposition for schizophrenia, yet never develop the disorder. Some researchers believe that one sign of this predisposition are problems in facial emotion recognition skills. Researchers believe that one factor that may help in reducing the risk of schizophrenia in these genetically predisposed people is better childhood training in facial expression recognition skills, and other related social skills - and research studies in this area are ongoing. Read more about this topic here and here. Below we summarize this recent study in more depth and provide links to additional readings.

The researchers in this study note:

"A key component of social cognition, facial expression recognition, is one of the hallmark deficits of schizophrenia."

What was the study on and why is it important?

This study wanted to find out if those with only a genetic vulnerability to schizophrenia, but not a diagnosis of schizophrenia would also have deficits in social cognition. This is of interest because it paints a bigger picture of how the genetics of schizophrenia can impact people. It’s important to know whether people with only a vulnerability, but not the full-blown disorder, have similar deficits, and may benefit from treatment. These findings on deficits in social cognition and facial expression are keys to preventions as well. Improving a child’s social cognition may mean the difference of high versus low functioning with schizophrenia, or not developing the disorder it at all.

How was the study done?

This study looked patients with schizophrenia (40 of them), their healthy siblings/brothers (30 of them, with no presenting psychiatric disorder), and compared their emotion recognition (which was facial expressions) to that of a control group (26 of them), with no genetic vulnerability--meaning no history of schizophrenia in the family.

The study tested emotional recognition of the participants by showing them 132 faces with varying emotions and asked the participants to choose which emotion was being shown by the facial expression. They also tested gender recognition as a control, to see if gender recognition performance would also differ between the 3 groups. It was tested the same way; 132 images where the participants were asked to pick the gender of the person shown.

To test for stability of emotional recognition, the researchers administered the 132 facial images twice. This was in the hopes of finding if the scores were better or worse over time. Some of the factors that may contribute to changes in the schizophrenia group are effects of stabilization of treatment, or degrading social cognition over time with the schizophrenia. This happens with general cognition and memory in many people who have schizophrenia – over time with the disorder memory and attention worsen. The schizophrenia group was given the test before receiving drug treatments, and after being stabilized on haloperidol.

What did they find?

They found that, "emotion recognition performance was distributed along a continuum between the control group and the schizophrenia group, with the siblings group midway between, whereas gender recognition was highly preserved in all groups."

This means that the control group performed best, and was the most successful at recognizing the emotion being expressed. The healthy siblings were the next successful at this task, but their performance was significantly impaired compared to the control group. And those patients with schizophrenia had the lowest number correct. But gender recognition was the same for all three groups.

Because they gave the test to the schizophrenia group twice, before drug treatment and after stabilization, they were able to show that these emotional recognition deficits were present prior to drug treatment, and therefore not caused by medication side effects.

This also showed that the testing results were stable prior to medication treatment and after--meaning stabilizing the patient, and relieving many of the symptoms of schizophrenia did not increase their emotional recognition abilities. This is very important because it shows that more than just medications are needed in the treatment of schizophrenia. Social skills learning, psychoeducation, and psychotherapy may prove to be more beneficial in increasing emotional recognition.

Interestingly, the "healthy" siblings didn’t show an overall deficit like the schizophrenia group did. They only had difficulty recognizing facial expressions of the emotions: Fear and Disgust. This is important because it suggests that onset of schizophrenia may cause the already present partial deficits to generalize. This can guide child education to fully develop social cognition skills like facial expression emotion recognition at an early age, before onset of schizophrenia. By reinforcing these skills at a young age, it may help decrease the amount of deficits experienced once the disorder sets in.

What does this mean for prevention and treatment?

"In social situations inaccurate decoding of emotional expression could be a source of stress and a barrier to deep social interactions and communication. It has been shown that metabolic and probably physical and social stress could cause an acute exacerbation of schizophrenia symptoms."

Not only could the social cognition skill building be important to prevent full generalizing of these emotional recognition deficits in those with schizophrenia, but it may also help prevent exacerbation the disorder. Even more so than exacerbating schizophrenia, the stress of inaccurate decoding may be a risk factor for the development of schizophrenia. There is a lot of support that social stressors
-- such as social defeat and isolation -- may contribute to causing schizophrenia.

Although there isn’t enough research to clearly connect emotional recognition with social stressors and development of schizophrenia, its reasonable to assume that building these skills in children will have some benefit on their social intelligence and hopefully foster resilience to mental illness.

Comments

My wife was recently diagnosed with schizophrenia. She gave birth to our only son 18 months ago. After the birth, she had a pyschotic episode and has relapsed twice since then. I've read a great book about mental disorders titled, "When someone you Yove Has a Mental Illness". This book mentioned facial recogintions. My wife would always smile whenver telling me of bad life experiences, and I always asked her why she was smiling. Unfortuntaley, now I know why. This is a very true sign of schizophrenia. I pray for my son every night, since he has this predispostion. This is a HUGE warning sign. I advise anyone to take this sign seriously. It may help in early detection with your children. God Bless.

Joe, Some people with no schizophrenia and none in their immediate family smile this way because they are being brave, trying to take the edge off the pain. A very nice older woman I have known for decades always smiles whenever talking about anything painful. I think it is her way of being sweet and benign. None of my 1/2 dozen family members with "mental illness" smiled inappropriately. So, unfortunately, we cannot use even this as a definitive warning sign. Seems like in retrospect I think, "this was a warning sign", and "that was a warning sign"... but then there are so many cases where it isn't. Even children hearing voices -- even something so "sure" is not so sure because some of the kids "outgrow it", or simply do not develop schizophrenia. We need so much better diagnostic methods.